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. 2024 Jun;33(6):e5846.
doi: 10.1002/pds.5846.

Use of electronic health record data to examine administrations of pro re nata analgesics during hip fracture post-acute care

Melissa R Riester  1   2 , Yuan Zhang  2 , Kaleen N Hayes  2   3 , Francesca L Beaudoin  1   2 , Andrew R Zullo  1   2   4
Affiliations

Use of electronic health record data to examine administrations of pro re nata analgesics during hip fracture post-acute care

Melissa R Riester et al. Pharmacoepidemiol Drug Saf. 2024 Jun.

Abstract

Purpose: Medications prescribed to older adults in US skilled nursing facilities (SNF) and administrations of pro re nata (PRN) "as needed" medications are unobservable in Medicare insurance claims. There is an ongoing deficit in our understanding of medication use during post-acute care. Using SNF electronic health record (EHR) datasets, including medication orders and barcode medication administration records, we described patterns of PRN analgesic prescribing and administrations among SNF residents with hip fracture.

Methods: Eligible participants resided in SNFs owned by 11 chains, had a diagnosis of hip fracture between January 1, 2018 to August 2, 2021, and received at least one administration of an analgesic medication in the 100 days after the hip fracture. We described the scheduling of analgesics, the proportion of available PRN doses administered, and the proportion of days with at least one PRN analgesic administration.

Results: Among 24 038 residents, 57.3% had orders for PRN acetaminophen, 67.4% PRN opioids, 4.2% PRN non-steroidal anti-inflammatory drugs, and 18.6% PRN combination products. The median proportion of available PRN doses administered per drug was 3%-50% and the median proportion of days where one or more doses of an ordered PRN analgesic was administered was 25%-75%. Results differed by analgesic class and the number of administrations ordered per day.

Conclusions: EHRs can be leveraged to ascertain precise analgesic exposures during SNF stays. Future pharmacoepidemiology studies should consider linking SNF EHRs to insurance claims to construct a longitudinal history of medication use and healthcare utilization prior to and during episodes of SNF care.

Keywords: analgesics; hip fractures; opioid; rehabilitation; skilled nursing facilities.

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Conflict of interest statement

A.R.Z received prior grant funding paid directly to Brown

University for collaborative research on the epidemiology of infections and vaccine use among nursing home residents. K.N.H. has received grant funding paid directly to Brown University for collaborative research from Insight Therapeutics, Sanofi, and Genentech for research on complex insulin regimens and influenza outbreak control in nursing homes. K.N.H. has also served as a consultant for the Canadian Agency for Drugs and Technologies in Health. The other authors declare that they have no competing interests relevant to the subject matter of the manuscript.

Figures

Figure 1.
Figure 1.. Scheduling of analgesic medications overall among residents in U.S. skilled nursing facilities following a hip fracture, January 2018- August 2021.
Presents proportion of residents overall (N= 24,038) prescribed PRN only, standing only, and both PRN and standing analgesics. Abbreviations: NSAIDs, non-steroidal anti-inflammatory drugs; PRN, pro re nata.
Figure 2.
Figure 2.. Scheduling of analgesic medications among residents in U.S. skilled nursing facilities who were prescribed acetaminophen, opioids, NSAIDs, and combination products following a hip fracture, January 2018- August 2021.
Presents proportion of residents prescribed PRN only, standing only, and both PRN and standing analgesics among residents receiving acetaminophen (n= 18,805), opioids (n= 17,092), NSAIDs (n= 2,722), and combination products (n= 4,706). Abbreviations: NSAIDs, non-steroidal anti-inflammatory drugs; PRN, pro re nata.
Figure 3.
Figure 3.. Timing of active orders for analgesics among residents in U.S. skilled nursing facilities following a hip fracture, January 2018- August 2021.
Presents proportion of residents (N= 24,038) with active orders for A) PRN analgesics and B) Standing analgesics during the skilled nursing facility stay. An order was considered active between the order start and end date. If the order start or end date was missing, the period when the order was active could not be determined. Abbreviations: NSAIDs, non-steroidal anti-inflammatory drugs; PRN, pro re nata.
Figure 4.
Figure 4.. Administration of PRN analgesics among residents in U.S. skilled nursing facilities following a hip fracture, January 2018- August 2021.
Presents proportion of available doses administered among residents with orders for PRN A) Acetaminophen, B) Opioids, C) NSAIDs, and D) Combination Products during the skilled nursing facility stay, by the frequency of analgesic ordered. The number of residents with orders for each medication class and frequency is listed in eTable 3. Abbreviations: NSAIDs, non-steroidal anti-inflammatory drugs; PRN, pro re nata.
Figure 5.
Figure 5.. Days with an administration of PRN analgesics among residents in U.S. skilled nursing facilities following a hip fracture, January 2018- August 2021.
Presents proportion of days with an active order where residents had one or more administrations of PRN A) Acetaminophen, B) Opioids, C) NSAIDs, and D) Combination Products during the skilled nursing facility stay, by the frequency of analgesic ordered. The number of residents with orders for each medication class and frequency is listed in eTable 4. Abbreviations: NSAIDs, non-steroidal anti-inflammatory drugs; PRN, pro re nata.
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